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- 1. NURSING CARE OF SPECIAL GROUPS PREPAREDBY VERSHA CHAUHAN MSc 1ST YEAR RAKCON
- 2. INTRODUCTION Community health nursesface the challenge of continually assessing each population’s current health problems, as well as determining available and needed services. Community health nursing interventions with maternal, infant, toddler, and preschool, adults, women, elderly, physically and mentally challenged populations are focused on health promotion and early intervention.
- 3. SPECIAL GROUPS Specialgroups are the groups which would be vulnerable under any circumstances (e.g. where the adults are unable to provide an adequate livelihood for the household for reasons of disability, illness, age or some other characteristic), and groups whose resource endowment is inadequate to provide sufficient income from any available source.
- 4. SPECIAL GROUPS INCLUDES Children Adolescents Women Elderly Physically and mentally challenged
- 5. CHILDREN A personbetween birth and full growth; a boy or girl. Neonate Under five age
- 6. GOVERNMENT INITIATIVES PRIORITYINTERVENTIONS Home-based newborn care and prompt referral. Facility-based care of the sick newborn. Integrated management of common childhood illnesses (diarrhea, pneumonia and malaria). Child nutrition and essential micronutrients supplementation & ICDS. Immunization. Early detection and management of defects at birth, deficiencies, diseases and disability in children (0–18 years) Other Schemes Include: – Balika Samriddhi Yojana (BSY) Kishori Shakti Yojana (KSY) Nutrition Programme for Adolescent Girls (NPAG) Early Childhood Education for 3-6 Age Group Children Under the Programme of Universalization of Elementary Scheme for welfare of Working Children in need of Care and An Integrated Programme for Street children
- 7. Home-based newborn careand prompt referral. Home-based newborn care scheme launched in 2011 provides immediate postnatal care and essential newborn care to all newborns up to the age of 42 days. ASHAs are trained and incentivized to provide special care to pre terms and newborns. ASHA are also trained in identification of illnesses, appropriate care and referral through home visits
- 8. Facility-based care ofthe sick newborn. Special Newborn Care Units (SNCU) have been established at District Hospitals and tertiary care hospitals. The goal is to have one SNCU in each district of the country and in health facilities with more than 3,000 deliveries per year. Newborn Stabilisation Unit (NBSU), which is a four- bedded unit providing basic level of sick newborn care, is being established at Community Health Centres / First Referral Units. Newborn Care Corners (NCC) at each delivery point
- 9. Integrated management ofcommon childhood illnesses (diarrhea, pneumonia and malaria). Availability of ORS and Zinc. Should be ensured at all sub-centres and with all frontline workers. Timely and prompt referral of children with fast breathing and/or lower chest in- drawing should be made to higher level of facilities. Training of health service providers (doctors and nurses), especially those at FRUs and District Hospitals in F- IMNCI
- 10. Child nutrition andessential micronutrients supplementation & ICDS Follow up of LBW baby by ASHA and ANM. Bi-weekly iron and folic acid supplementation for preschool children of 6 months to 5 years as part of the National Iron + initiative. Administration of deworming tablets/syrup combined with Vitamin A supplementation during biannual rounds.
- 11. Immunization Second doseof measles has been introduced and Hepatitis B vaccine is now available in the entire country. To strengthen routine immunization, newer initiatives include- provision for Auto Disable (AD) Syringes to ensure injection safety. Support for alternate vaccine delivery from PHC to sub-centres as well as outreach sessions. Mobilization of children to immunization session sites by ASHA. Coverage of vaccine beyond first year of life must be emphasised and monitored. Investigation report of every serious ‘adverse event following immunisation’ (AEFI) case must be submitted within 15 days of occurrence to district AEFI Committees.
- 12. Early detection andmanagement of defects at birth, deficiencies, diseases and disability in children (0–18 years) Child Health Screening and Early Intervention Services (Rashtriya Bal Swasthya Karyakram) This initiative aims to reach 27 crore children annually in the age group 0-18 years. Child health screening and early interventions services will be provided by mobile health teams at block level. These teams will include- at least 2 doctors (MBBS /AYUSH qualified)- 2 paramedics. The health screening will be conducted to detect 4Ds: defects, deficiencies, diseases, development delays including disabilities.
- 13. Balika Samriddhi Yojana(BSY) It was introduced in 15th August 1997, under the policies for women and child development to facilitate the girl child. It is widely known as the key initiative to support the birth and education of the girl child. Initially, under BSY there were incentives assimilated – a gift of rupees 500 presented to the mother on delivery of the girl child also annual scholarship were provided for the childs’ education by the government.
- 14. Kishori Shakti Yojana(KSY) It is a scheme initiated by ministry of women and child development in India, implemented by government of ODISHA for juvenile girls age group 11-18 years under the ICDS programme. Its aim is to empower adolescent girls, to motivate them to be self reliant, assist them in studies and vocation, promote health care and gives them exposure to society for gaining knowledge so that they can grow into responsible citizens. It launched in 31st August 2007.
- 15. Nutrition Programme forAdolescent Girls (NPAG) Introduced in the year 2002-2003 with 100% Central Assistance. Aims:- 1. Improve Nutritional and health status adolescent girls. 2. Provide nutrition and health education to the beneficiaries. 3. Empower adolescent girls through increased awareness to take better care of their personal health and nutrition needs. Beneficiaries:- Adolescent girls <35 Kg Pregnant women <45 kg Services 6 Kg ration per month for three months consecutively. Implemented through the A.W. Centres Weighing four times in a year on the basis of the body weight, issuance of live rice will continue for 3 months. In Assam, Kokrajhar and Karbi-Anglong as pilot districts.
- 16. An Integrated Programmefor Street children OBJECTIVE- Provisions for shelter, nutrition, health care, sanitation and hygiene, safe drinking water, education and recreational facilities and protection against abuse and exploitation to destitute and neglected street children.
- 17. Child lineServices Central Adoption Resource Agency Rajiv Gandhi National Crèche Scheme For the Children of Working Mother Programme for Juvenile Justice General Grant-in-Aid Scheme Pilot Project to Combat the Trafficking of Women and Children for Commercial Sexual Exploitation in Destination Area Mid-day Meal Scheme National Crèche Fund
- 18. Mid-day Meal Scheme It is a school meal programme of government of INDIA, design to better the nutritional standing of school age children nation wide. Launched in 1995. The programme supplies the free lunches on working days for children in primary and upper primary classes.
- 19. Child line Services Child line is 1098 is a service of ministry of women and child development. Child line India foundation is a non government organization in India that operates a daily phone helpline called child line, for children in distress. It was India’s first 24 hours call tollfree, phone outreach service for children. Child line 1098 is available all over India.
- 20. Central Adoption ResourceAuthority It is a statuary body of ministry of women and child development. It functions as the nobal body for adoption of Indian children and mandated to monitor and regulate in country and inter country adoptions. CARA primarily deals with adoption of orphans, abundant and surrendered childrens through its associated/ recognized adoption agency.
- 21. Rajiv Gandhi NationalCrèche Scheme For the Children of Working Mother National crèche scheme (earlier name as Rajiv Gandhi National crèche scheme). Is being implemented as a centrally sponsored scheme through states / UTs with effect from 1 January 2017 to provide day care facility to children (age group of 6 months to 6 years) of working mothers.
- 24. Why pay attentionto the health of an adolescent To reduce death and disease in adolescents: An estimated 1.7 million young people aged from 10 to 19 die each year due to accidents, violence, pregnancy related problems or illnesses. To reduce the burden of disease in later life: Malnutrition in adolescence can lead to lifelong health problems. Failure to care for the health needs of young pregnant women damage their own health and that of their babies. Some of the highest infection rates for sexually transmitted infections are in adolescents. Diseases of late middle age, such as lung cancer, bronchitis and heart disease, are strongly associated with smoking habit.
- 25. To investin health today and tomorrow: Healthy and unhealthy practices adopted today may last a lifetime. Today’s adolescents are tomorrow’s parents, teachers and community leaders. Adolescence is a period of curiosity, when young people are receptive to information about themselves and their bodies, and when they begin to take an active part in decision making. To protect human capital In some societies two out of three adolescents are involved in productive work only due to injury, illness or psychological damage where the cost is primarily a human one, but there is also a cost to society.
- 26. GOVT. INITIATIVES Adolescenthealth programmes RMNCH+A Rashtriya Kishor Swasthya Karyakram (RKSK) Kishori Shakti Yojana : To improve the health and nutritional status of girls Nutrition Programme for Adolescent Girls (NPAG) Balika Samridhi Yojana WIFS (weekly iron folic acid supplementation) National AIDS Control Programme Adolescent Friendly Health Clinics(AFHCs)
- 41. WOMEN Gender isone of many social determinants of health—which include social, economic, and political factors—that play a major role in the health outcomes of women in India. Therefore, the high level of gender inequality in India negatively impacts the health of women.
- 42. STATUS OF HEALTH The low status of—and subsequent discrimination against—women in India can be attributed to o cultural norms. Societal forces of patriarchy, Hierarchy Multigenerational families
- 43. Highest rateof malnourishment. 50% of pregnant /non pregnant anaemic. A 2012 study by Tarozzi have found the nutritional intake of early adolescents to be approximately equal. However, the rate of malnutrition increases for women as they enter adulthood. Furthermore, Jose et al. found that malnutrition increased for ever-married women compared to non-married women.
- 44. Govt. Initiative Allthe elements of RCH- II integrated in NHM • Essential Obstetric Care • Quality Ante Natal care • Post natal care for mother and newborn • Skilled Attendance at Birth • Provision of Emergency Obstetric and Neonatal Care at FRUs • Augmentation of skilled human resources for Maternal Health Safe Abortion Services/ Medical termination of Pregnancy (MTP) Supply of Nischay Pregnancy detection kits to sub centres Maternal Death Review MCTS A Joint MCP Card JSSK Gender Based Violence (detection & support) Setting up of Blood Storage Centre (BSC) at FRUs Scheme for promotion of menstrual hygiene among adolescent girls in rural India
- 45. MCTS Mother &Child Tracking System (MCTS), web based reporting software, under RCH-II programme for tracking of health services delivered to pregnant mothers and children. • Objectives:- • Name Based Tracking of: 1. Pregnant women - for ANC, Delivery & PNC health services 2. Children - for immunization To Facilitate: 1. Close monitoring of regular Checkups & service delivery to pregnant mothers with minimum essentials services 2. Full Immunization of Mother & Children 3. To follow up dropouts and track service delivery 4. To promote complete immunization and safe institutional deliveries
- 46. Tracking System •New registration – 18 digit UNIQUE ID • Service delivery record update • Allotment of health provider – • Overdue services for same beneficiary for every month are generated in health provider’s work plan. • In rural area two health providers (one ANM & one ASHA) are allotted to each beneficiary. • SMS alerts to beneficiary & health provider – For the information of registration status and services falling due on the mobile number registered in MCTS.
- 47. Janani Shishu SurakshaKaryakaram (JSSK) Janani Shishu Suraksha Karyakaram (JSSK) Under this scheme services are provided to pregnant and deliverd mothers and infants up to 1 year are getting benefitted in all government health facilities by all free health services irrespective of poverty level, caste and parity. 1. Free drugs & Consumables 2. Free Referral Transport 3. Free Diagnostics 4. Free Diet To Delivered Mothers 5. Provision of Free Blood 6. Exemption from User Charges
- 48. A Joint MCPCard MCP Card is the means of verification for conditionalities and service uptake. Joint use of the same MCP card by AWW and ANM ensures better field level service convergence. MCP Cards are supplied by Health, and issued by AWWs immediately on registration to all Pregnant Women
- 49. Nischay Pregnancy detectionkits Services for early detection of pregnancy. Surveys indicate availability of pregnancy detection kits (NISHCHAY) with peripheral health functionaries. ASHAs performed over 82 percent of tests themselves. The Ministry of Health and Family Welfare (MOHFW), GOI, through National Rural Health Mission (NRHM) has introduced rapid home pregnancy test kits (Nishchay). Taking a holistic view of the concept, Nishchay is not a program for the promotion of the pregnancy test kit alone, but is an entry point to RCH and family planning services for women seeking quality and assured RCH and FP services.
- 50. ELDERLY 60-69 Old 70-79 Old - Older 80+ Oldest- Old 60-74 Young Old 75- 84 Middle old 85+ Old-Old Source: National Policy on Older Person 1999 GOI
- 51. Community Geriatrics Caringfor older patients means not only understanding their diseases and knowing who the support people are in their lives, but also creating a plan of care that includes their social, financial and personal goals.
- 52. GENERAL PROBLEMS INOLD AGE Economic problems Sociological changes Spiritual changes
- 53. System wise changes Cardiovascular changes Respiratory system Gastrointestinal system Neurological system Acidents
- 54. Various Levels ofhealthcare Primary Level: Good health habits like: Good sleep Good and required nutrition Curtailing smoking, alcohol and fatty foods. Avoidance of overeating (Obesity control) Avoiding risk factors like: | Care at routine to avoid accident, fracture. Diet restrictions. Periodic health checkup
- 55. Secondary prevention • Screening for hypertension, diabetes periodontal disease dental caries • sensory impairment medication side effects • colon-rectal cancer breast cancer, cervical cancer and prostatic cancer nutritionally-induced anaemias depression, stress urinary incontinence podiatric problems fall risk • Annual medical check-up • Early detection ( Universal approach, Selective approach)• Treatment
- 56. Tertiary prevention • Rehabilitation - physical deficits cognitive deficits functional deficits • Caretaker support -Introduction of support necessary to prevent loss of autonomy. • Counselling and Welfare activities ( Sanjay Niradhar Yojana, Vridhashrama ) • Improving quality of life • Cultural programme • Old age club • Home help • Old age home
- 57. How government helpold age people • Government announced a National Policy on older persons in January 1999. • This policy identifies principal areas of intervention as security, healthcare, nutrition, welfare and protection of life and property. • A national council for older persons (NCOP) was constituted to operationalise this policy . • 234oldage home,398 daycare centers and 40 mobile medical units are operational under this policy.
- 58. Under NationalSocial Assistance Programme, old age pension is being provided to more than 4 million aged people. • Old Age Social and Income Security (OASIS) was launched to examine policy questions, connected with Old age income security. • Health care is provided to the older people under Bhavishya Arogya Mediclaim and Rural Group Life insurance Schemes .
- 59. Help AgeIndia is the largest voluntary organization working for the cause and care of the older people. • Help Age India supports various programmes to make life easier for older people like 1. Free cataract operations 2.Mobile medical units 3.Old age homes and care centers. 4.Adopt a gran (grand parent). 5. Income generation and micro –credit.
- 60. NATIONAL PROGRAMME FORTHE HEALTH CARE OF THE ELDERLY (NPHCE) NPHCE is an articulation of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP) adopted by the Government of India in 1999. NPHCE would operate through NCD cells under the programme constituted at State and District levels.
- 61. You do notheal old age. You protect it; you promote it; you extent it. -Sir James Sterling Ross
- 62. NURSES CARE INPHYSICALLY AND MENTALLY CHALLENGED PERSON HANDICAPPED Handicapped child is one who deviates from normal health status either physically, mentally or socially and requires special care, treatment and education. DEFINITION According to WHO, the sequence of events leading to disability and handicapped conditions are as follows Injury or disease Impairment, Disability, Handicap
- 63. CLASSIFICATION OF HANDICAPPED CHILDREN Physically handicapped Mentally handicapped Social handicapped
- 64.
- 65. PREVENTION OF BLINDNESS Provide good antenatal care Immunization – meseals, rubella Genetic counseling and screening Prevent infection Prevent pre term birth and Provide excellent neonatal care to pre Vitamin A supplement Health education about eye safety, personal hygiene and nutrition for health promotion Treatment of causes of childhood blindness Retinopathy of prematurity (ROP) Cataract Glaucoma
- 66. MANAGEMENT OF BLINDNESS Physiotherapy Orientation and mobility instructors Mobility aid and guides BRAIL technology
- 67. DEAFNESS A personwho is not able to hear as well as someone with normal hearing. It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds.
- 68. LEVELS OF HEARINGIMPAIRMENT Mild deafness 25 to 39dB Moderate deafness 40 to 69dB Severe deafness - 70 to 89Db Profound deafness - 90dB <
- 69. MANAGEMENT Sign language Hearing devices - hearing aids, assistive listening devices and cochlear implants. Lip-reading skills Speech therapy Use of written or printed text
- 70. SPEECH HANDICAPPED Meansan impairment of speech or sound production, fluency, voice or language which significantly affects a child’s educational performance or their social, emotional or vocational development.
- 71. MANAGEMENT Earlyidentification of speech impairment Elimination of hearing impairment Medical and surgical intervention for underlying causes Psychological counseling Avoid making fun of their voice or speech Voice or Speech therapy Physical therapy Cognitive rehabilitation
- 72. ORTHOPEDICALLY HANDICAPPED Orthopedicdisability occur when movements in over body are affected due to disease, injury, any absence or deformities in the joints, bones, muscles or an injury in nervous system Loco motor disability means disability of the bones, joints or muscles leading to substantial restriction of the movement of the limbs
- 73. MANAGEMENT Correction ofDeformities Physical Therapy Occupational Therapy Massage Therapy Prosthetics devices for positioning and mobility
- 74. MENTAL HANDICAPPED Amental handicap is an impairment in an individual's ability to function cognitively, emotionally or physically due to the presence of a psychiatric condition. This condition hinders someone's ability to perform a task or prevents that person from engaging in an activity without assistance.
- 75. MENTAL RETARDATION Mentalretardation is defined as significantly sub average general intellectual functioning, resulting in associated with concurrent impairment in adaptive behavior, which manifests during the developmental period”. (American Association on Mental Deficiency)
- 76. MENTAL RETARDATION LEVEL Mild- 50- 70* Moderate - 35-50* Severe - 20-35* Profound <20
- 77. TREATMENT MODALITIES Behavior management. Environment supervision Monitoring the child’s developmental needs and problems. Programs that maximum speech, language, cognitive, psychomotor, social , self-care, and occupational skills. Family therapy Early intervention programs for children younger than age 3 with mental retardation. Provide day schools to train the child in basic skills, such as bathing and feeding.
- 78. SOCIALLY CHALLENGED CHILDREN A Socially handicapped children may be defined as a child whose opportunity for a healthy personality development and full unfolding of potentialities are hampered certain elements in his social environment such as parental inadequacy, environmental deprivation, (lack of learning opportunity) and emotional disturbance.
- 79. CATEGORY OF SOCIALLYHANDICAPPED CHILDREN Orphan Neglected children Children of divorce or step parents Delinquent children
- 80. Management For Parents Treatment for Substance abuse. Depression or other mental health problems. Low self-esteem Violent behavior realize responsibility regarding child educating and helping parents to correct their erroneous thinking and behavior or parenting skills.
- 81. For Child Child-centered interventions include pediatric care, mentoring Behavioral and mental health treatment. Provide stimulation programme to emotionally neglected child Develop timely and comprehensive assessments or placed in foster home
- 82. PREVENTION OF HANDICAPPED CONDITIONIN CHILDREN PRIMARY PREVENTION Genetic counseling Genetic screening Reduction of consanguineous marriage Pregnancy planning Rh incompablity Immunization of mother and baby Vitamin A prophylaxis Improve nutritional status of mother and child Prevention of iodine and folic acid deficiency Provide essential care in prenatal, Intranatal, postnatal period Prevent maternal and neonatal infection Prevent birth injury, asphyxia, hyperbilurubinemia Special care to high risk mother –abortion, premature birth Encourage to kick bad habits such as smoking or alcohol abuse.
- 83. SECONDARY PREVENTION Careful history Regular medical supervision and developmental assessment Treatment of particular handicap condition Correction of deformity Physiotherapy and exercise to improve physical condition Occupational therapy Speech therapy to improve communication ability Prosthetics Special care for mentally handicapped children with warmth , love , tolerance, discipline, avoid criticism Counseling and guidance Referral for welfare services
- 84. REHABILITATION OF HANDICAP CHILDREN Medical rehabilitation Social rehabilitation Educational rehabilitation Psychological rehabilitation Vocational rehabilitation
- 85. WELFARE OF HANDICAPPEDCHILDREN Persons with disabilities bill (equal opportunity, protection of right and full participation)- 1995,introduced by ministry of welfare and Govt of India and it deal with preventive and promotional aspect of rehabilitation Children Act 1960- provide for the care protection, maintenance, welfare, education, and rehabilitation of socially handicapped children.
- 86. Schemes for handicappedchildren Deendhyal disabled rehabilitation scheme Assistance to disabled person to purchase or fitting of aids and appliance National handicapped finance and development cooperation Scheme for implementation of person with disabilities act 1995(sipda) Scheme for incentive to employees in the private sector for providing employment to person with disabilities
- 87. National institute forhandicapped National institute for orthopedically handicapped Calcutta National institute for mentally handicapped Hyderabad Ali yavar Jung National institute for hearing handicapped Mumbai National institute for rehabilitation, training, and research Calcutta National Institute for visually handicapped New Delhi and Dehradun